When one is placed with a skilled nursing facility (SNF) they are given several options of payment (cash, Medicare, Medicaid, cash via long term care insurance). With the average SNF along the Panhandle of Florida charging approximately $7,500 per month it is extremely important to understand each source of payment:
Medicare unfortunately only pays for rehabilitation for 20 days. It will continue with a co-pay beyond that time period for up to 100 days.
Long term care insurance often only covers a portion of the daily expense. Further most policies have a cap which is reached within the first 24-36 months.
Most who visit a SNF would convince themselves that the average person is private paying (using their cash). This would be an incorrect assumption. Most individuals lack the ability to private pay. Estimates vary around the country; however, when rehabilitation days are removed (those first 100 days) it is common to find 80% or more of those in a SNF lack the cash or long term care insurance to cover for more than 12 months. This results in those individuals being placed on Medicaid.
Medicaid is a Federally mandated program (meaning the states have to offer it for SNFs). The program is often confused with Medicare; however, the programs are very different. One must meet an eligibility requirement with Medicaid beyond age and/or disability. It is important to be aware that there are various Medicaid plans available to families. The one dealing with SNFs is called ICP Medicaid. It should not be confused with its walfare cousins. This is a federal insurance program.
Gross income for the applicant - Less than $2,199 month. If higher you will need a QIT trust.
Gross income for the spouse - Unlimited unless using part of applicant’s money
Spousal support - min. $1,966 max. $2,931
Assets allowed for the applicant - $2,000
Assets allowed for the well spouse - $119,220
One can see why many people do not believe they qualify for Medicaid. However, what they do not realize is that some assets do not count towards those totals. For example a person’s house does not count (valued less than $536,000). A person’s car, funeral plan, personal property, certain retirement accounts all do not count. Therefore many people may be closer then they realize. The attorney’s role in this is to take a person who does NOT qualify and help them obtain Medicaid coverage. There are planning options available that can help a family obtain Medicaid even if they are already in the nursing home facility. We firmly believe it is never too late!